Q&A: The Surprising Upside of Getting Old

Americans have tremendous fear of aging — and a great deal of prejudice against the elderly. But, as the joke has it, being old is better than the alternative. And, despite our fears, new research suggests that being old is also a lot better than it looks.

I spoke with Dr. Marc Agronin, whose new book, How We Age: A Doctor’s Journey Into the Heart of Growing Old, explores these issues through the rich stories of his patients’ lives. Agronin is the psychiatrist for the Miami Jewish Health Systems, a nonprofit that is the largest provider of health care for seniors in the Southeast.

What led you to want to work with older people?

When I went to medical school, I knew I wanted to go into psychiatry, that was a given. In my second year, by a chance encounter I began working with a geriatric psychiatrist and I loved the work. I took an immediate interest in working with older patients. They reminded me not only of my grandparents but also of my wonderful aunts and uncles. I felt that there was so much I could learn from these elders that I was just drawn to it and never looked back.

Many people would think that would be a very depressing field of medicine.

I see that all the time and experienced it even when I was doing my training. The older patients were often the ones that the students didn’t want to be around.

[But] the difference wasn’t just in attitude for me: whenever I had experience with older individuals I quickly had deep appreciation for not only their life experience, but also the gratitude they had when someone younger would spend time with them. It was always a positive experience. I never regarded it as something frightening or unpleasant.

I love the stories they tell and hearing about history. So, for me, writing this book was natural — it would be full of stories.

Research now suggests that as we age, our moods improve and we actually grow happier.

There’s great potential. It didn’t occur to me right away how much people learn and grow as they age. That message really transformed my view of aging. I wasn’t trained to look for strengths, but found over time that those strengths are the things that get people through difficult times, whether psychological or spiritual or emotional. They also allow people not only to overcome challenges but even to thrive. The more I saw, the more impressed I was.

Aging, in spite of the inevitable [challenges], is a long process and has its rewards. Amid all the challenges, often the rewards not only balance things out, but most individuals experience a greater degree of well-being and a deeper sense of meaning than they do when they are younger. I often find I get a little taste of that. I feel when I’m with older individuals, I’m as close to the fountain of knowledge as one can get.

But as a physician, aren’t you faced constantly with incurable conditions like dementia?

We have to acknowledge that aging brings great challenges. It brings us closer to the end of life. I would never deny those facts. My job is to face them on a daily basis with individuals. Those I end up seeing in the nursing home are in the most dire situations.

Because of my position as doctor, I’m charged with finding solutions to problems that are very tenacious. One is always looking for ways to improve a situation. [But] the connections that people are able to make — whether between doctor and patient, or between grandchild, parent and adult children — can be so rich and can help buffer the difficult emotions that can come with aging.

How common is dementia and how do you cope with it?

In people 85 and older, the rate of Alzheimer’s disease approaches 50% and that’s just Alzheimer’s. There are other forms of dementia as well. For many people, this is the brick wall of aging. They can envision a good old age except if they develop dementia. It’s one of the greatest fears, and every little memory lapse brings up the specter.

Based on my clinical experience, individuals still retain their humanity even as they lose their memory. And they really rely on other individuals to keep them vital. The best we can do now — someday, hopefully, we will have a cure — in the interim, there is both a moral imperative as well as a great opportunity to be there with someone and do everything we can to enrich life. And I see that happen every day.

A lot of people say they would rather be dead.

The people who say that universally don’t have Alzheimer’s. Because just like with any other fear, we project ourselves into it when we are well. When it actually happens, most of time people and family rally. They find ways to deal and cope. It’s not like they wake up one day suddenly completely demented. It’s slow and there’s a long time to adapt. We’re working furiously to find a cure and the hope is that baby boomers may live to see the cure.

It’s very hard on the caregivers.

That’s the bulk of my work, working with caregivers. If you look at caregivers, rates for depression are higher. In our program, we’re very aggressive with caregivers and provide as much attention to them as we do to individuals suffering from dementia. The better the caregiver is doing, the better the person with the disease is doing.

We help caregivers cope with who the person is now and trying to balance what’s still there, and meet them at that level. The ones who do better are able to take changes in stride and adjust. Caregivers with more denial tend to struggle more.

Do your patients become more religious or spiritual?

I find two things. One is that ritual plays a more important role. Rather than prayer, it’s lighting the Sabbath candles, meeting with clergy — the behaviors themselves provide comfort. I think it’s because rituals tap into deep strengths and conjure up for most people pleasant memories.

Also, I don’t see individuals reflecting as much about what death is about. It’s more about “What can I do on a daily basis to deal with loss of loved ones, stress and pain?” It really is more day-to-day life rather than larger causes and issues.

So people aren’t obsessed with fear of death?

Nine hundred ninety-nine times out of 1,000, individuals say that they don’t have fear of death. What they fear is pain. They are ready. They don’t know what will happen, some even welcome it. [Still], they almost never say they’re afraid of death. There’s a degree of denial but most of the time, they’re happy to talk about it and they’re very matter of fact. Many have been through losses. Many have had life-threatening experiences. When you get to that point, death is not such a stranger.

That’s surprising to me.

I agree. That’s why I usually ask about it. I think, “How can they not be?” It always baffles me. But what people told me seemed to be the opposite of what I expected. My personality at 45 is so different compared with those of people in their 80s and 90s.

In fact, the studies show that well-being improves, and stress and worry decline, as people age. The older brain is apparently less reactive to negative experience.

Think about the teenage brain; it’s a different brain than that of 30- and 40-year-olds. The older brain is different in similar ways. At 18, you can’t have the personality of a 40-year-old. It’s terrifying to think about being 40 or 50. You can’t really imagine what it’s like to be 80 and 90. When you get there, it’s not what you imagine.